No abstract

The purpose of this study is to characterize the sonographic appearance of canine parathyroid glands using high-resolution ultrasonography. Ten cadaver dogs were studied after euthanasia for reasons not relating to the parathyroid. The cervical region was examined using a 13-5 MHz linear transducer in right and left recumbency. Ultrasonographic features of the parathyroid and thyroid glands were compared with the gross and histopathologic findings. Thirty-five structures were identified sonographically as parathyroid glands but only 26 of 35 glands (74% positive predictive value) were proven to be normal parathyroid glands histopathologically. Of the nine false positives, five (14%) were proven to be lobular thyroid tissue. The remaining four (11%) structures were visible grossly or found histopathologically. There were no statistical differences between ultrasonographic and gross measurements of the parathyroid glands. The average size as seen sonographically was 3.3 x 2.2 x 1.7 mm and the average gross size was 3.7 x 2.6 x 1.6 mm (length, width, height). The average size of the thyroid lobules assessed sonographically was 2.3 x1.6 x 0.8 mm (length, width, height). Normal parathyroid glands can be identified using high-resolution ultrasonography. But some thyroid lobules will be misinterpreted as parathyroid glands; this will result in false positives when identifying parathyroid glands with ultrasonography.

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Neurogenic thoracic outlet syndrome (nTOS) develops secondary to repetitive motion of the upper extremity. Competitive athletes (CAs) performing repetitive motion in their respective activities are at risk for nTOS. First rib resection and scalenectomy (FRRS) may be required for symptomatic relief and return to competition. This vulnerable population has not been previously studied for the results of FRRS.Methods: Demographic, historical, procedural, and follow-up data for every patient treated (by the senior author) for nTOS from July 2009 to May 2014 were entered into a dedicated data base. These patients were contacted to complete a nine-question survey to assess the effect FRRS on pain medication use, postoperative physical therapy duration, patient satisfaction (willingness to do the surgery again), symptom relief, effect on activities of daily living, athletic performance, time to return of athletic performance, and need for other surgeries (of the neck, shoulder or arm). A multivariate analyses of the following risk factors: age, pectoralis minor release, preoperative narcotic use, athletic shutdown, and involvement in a throwing sport were performed.Results: During the study period, 564 patients had FRRS for nTOS. There were 221 competitive athletes and 67 (35 male, 32 female) with an average (range) age of 19 (14-48) years responded to the survey. The breakdown consisted of 48 (72%) white and 19 (28%) nonwhite patients participating in the following sports: baseball/softball (45), volleyball (8), band/musician (3), cheerleading/gymnastics (5), diving (1), football (1), swimming (1), other (1), and who performed at the high school (36), collegiate (24) and professional levels (7). Survey results (Tables I and II) revealed that 90% were improved in pain medication use, 75% would undergo FRRS on the contralateral side if needed, 82% had resolution of TOS symptoms, 94% were able to perform activities of daily living without limitation, 73% returned to at least the same or better level of athletic activity after FRRS, and this occurred within 1 year in 70%. Although 37% of respondents required another procedure after FRRS overwhelmingly 95% felt that they had made the right decision. Multivariable regression analysis showed increase in age to significantly increase the duration of supervised physical therapy, and pre-op narcotics use to be associated with increased resolution of nTOS symptoms. Other risks factors were statistically insignificant.Conclusions: The majority of CAs are able to return to their precompetitive state after FRRS and few have limitations in their activities of daily living. Although additional procedures are necessary in over one-third of these patients, almost one-half returned to competition by 6 months and the majority within 1 year. The vast majority of the CAs are pleased with their decision to have FRRS and would do it again. Further investigation remains to be done for predictive factors for successful return to competitive athletics in this population.

Patients presenting with a PAA at 20 mm or >20 mm in diameter, presence of luminal thrombus, or atrial fibrillation may need to be observed at more frequent scanning intervals than those without these risk factors. Further studies are required to validate these predictive growth factors.